peds

Question 1

cleft lip

Answer 1

1:1290 incidence

Question 2

white roll

Answer 2

junction between skin and dry vermillion

Question 3

red roll

Answer 3

junction between dry and wet vermillion

Question 4

bilateral cleft and prolabium

Answer 4

use to reconstruct the tubercle, do not include any white roll, just skin

for 3mo use 6-8mm
5 years 9-11mm
adult 12-15mm

you will have bilateral tubercle flaps and no c flap
otherwise mark same as unilarteral in principle, can keep the wet mucosa as needed

Question 5

bilateral cleft lip pits

Answer 5

Van der woude syndrome
AD

Question 6

multidisciplinary team (CUPID)

Answer 6

plastics surgery, ENT, speech, child psych, audiology, genetics, meds dentistry, orthodontics, OMFS, SW

Question 7

when to repair cleft lip? rule of 10s

Answer 7

10lb weight
10hgb
10weeks

ok to delay due to NAM

Question 8

simonart band

Answer 8

weblike band connecting medial and lateral elements

Question 9

weight gain pace

Answer 9

half pound every other week after 2wks of life

Question 10

bilateral cleft lip the prolabium marked 2-2.5mm apart on the lower boarder forming the cupids bow. It narrows as it approached the columella generally 6-8mm

Question 11

ZONA PELLUCIDA

Answer 11

diastasis of the levator muscles

Question 12

questions to ask parents re prenatal

Answer 12

drug exposure (seizure meds, steroids), alcohol, smoking, illicit drug use, gestational age? family hx of orofacial cleating? feeding? weight gain?

look at mandible, look at hands and feet, full physical, genetic testing, kidney US, echo, X-ray of spine

Question 13

cleft palate without cleft lip has a 40% incidence of syndromic presentation

Question 14

Haberman bottle

Answer 14

part between the reservoir that you can squeeze to pass milk along into the teat

Question 15

primary palate

Answer 15

anterior to incisive foramen

Question 16

Bardach repair (two flap palatoplasty)

Answer 16

raise two mucoperiosteal flaps based of the greater palatine vessels,

Question 17

vomer flap

Answer 17

septomucosal flaps raised and used to help close the nasal mucosa

Question 18

tensor vili palatini and levator vili palatini

Answer 18

TVP goes around hamulus

Question 19

draw a furlow

Question 20

PRS

Answer 20

glospotosis, micrognathia, airway obstruction

Question 21

Micrognathia

Answer 21

bronchoscopy, nasal endoscopy, look for anatomic causes aside from jaw
sleep study
CT

laryngomalacia, tracheomalacia, subglottic webs

Question 22

distraction

Answer 22

begin the next day for kids
wait 5 days for older patients

rate is 2mm/day for neonates
1mm/day for adults

consolidation 4-8 weeks

confirm ossification on xray

Question 23

microtia

Answer 23

description of small, malformed,hypoplastic residual cartiladge
unilateral? bilateral? anotia?

eam absent? hearing loss? BAHA?
hx of cleft? hand conditions? craniofacial anomalies?

Visual impairment - oculoauriculovertebral ssyndrome
Renal - brachio-oto-renal syndrome
Cardiac - CHARGE

hemifacial microsomia? Goldenhar? (epibulbar dermoid and pre auricular skin tags)
Goldenhar - malar hypoplasia, micrognathia
Nager - high nasal bridge and broad thumb

STUDIES?
CT, audiometric studies

USUALLY HAVE HEARING LOSS NOT SENSINEURAL»»SO DO BAHA PRIOR TO RECONSTRUCTION

ISSUES WITH NAGATA?
pneumo, chest contour, infection, chrondrities, residual asymmetries,

PERFORM MIDDLE EAR RECONSTRUCTION BEFORE EXTERNAL EAR

PROTECT PATIENT HEARING TO ASSURE THEIR SPEECH DEVELOPS OK`

Question 24

nasoendoscopy reveals lack of lateral pharyngeal and posterior pharyngeal wall motion

Answer 24

spinner pharyngoplasty…..with bilateral palatopharyngeaus/posterior tonsillar pillar flaps transposed horiont\zally to a transverse incision made at the junction of the posterior pharyngeal mucosa and adenoid tissue at the level of the atlas

Question 25

nasoendoscopy shows good lateral wall motion but velum is not hititing the posterior pharyngeal wall

Answer 25

pharyngeal flap, can lengthen the velum via furrow or via bilateral buccal flaps

Question 26

active velar closure from velum and lateral pharyngeal wall are closing around the velum leaving a small midline defect…..

Answer 26

occurs due to midline muscle deficiency, these patients benefit from furlow

Question 27

poor motion of velum and lateral pharyngeal wall?

Answer 27

pharyngeal flap vs obturator to elevate the velum

Question 28

diGeorge 22q11 vs velocardiofacial syndrome

Answer 28

poorter outcomes with after palatoplasty, may need pharyngeal flap, get an MRA to evaluate for midealized ICA